it is about how you fight, all right. you can defeat opposition but you may not kill a whole people, that's genecide, you may not commit crime against humanity and may not commit war crimes. i don't think that you would have designed an intervention that would have forced him to the table. this should never be in absence of a diplomatic process. michael and i agree. you never going to win in syria, you never were militarily. how do you combine the credible threat of force and diplomacy to stop the fight? >> you'll be happy to know that

you'll get the last word because we are out of time but thank you all for such an interesting discussion, michael and anne marie. our conference staff will be happy to show you the way. thank you. >> thank you. [inaudible conversations] are you book tv is on facebook. author information and to talk directly with authors during our

live program, facebook.com/booktv. >> good evening. on matter of law of the entire staff, welcome. it's a pleasure to have you here and a pleasure to be hosting sonia shah. if you have electronic devices, if you would silence them now. we encourage questions, but need

you to use -- actually the one microphone that's here on the right by the pilar, so that everyone can be involved in the conversation and also for c-span audience. after the event is over, if you -- great help if you fold up the chair and it will be time for the book signing and the books are for sale when you walked in. sonia is an investigative author who worked in new york times and scientific american, among others. the story of oil, body hunters, testing new drugs on the world's poorest patients and the fever, how mill warria has ruled human kind for 50000 years. history of outbreaks including the housebreaks of them and responses to them as a reporter where it affects people's live and discussing what we now know and predict next outbreak,

please welcome sonia shah. [applause] >> thank you, thank you you all for coming. by my fifth book, i will be right on time. that's exactly where we are with the zika virus watching over the americas and i just heard the cdc report that three out of the nine women who came back to the united states have had abnormalities in the babies, so it seems like this thing is actually -- might actually have

not just in brazil, but the zika virus is just a good example of what's been going on generally over the past decade and it's the reason why i wrote this book, which is over the past 50 years we've had over 300 infectious pathogens. zika is just the latest, we had ebola in west africa where it had never seen before, influenza and outbreak of animal disease history. we had viruses, a virus coming out of the middle east and, of course, all of the antibiotic resistance pathogens, zika, west nile virus, a whole number of things. what i wanted to look at as a

journalist is how does a microbe, a tiny little thing, how does it become this pandemic pathogen. first i looked at the history of pandemix and one of the most successful pathogens, it's caused seven. it kills half of the people that are infected with it, this can happen in a matter of hours unless they are rapidly treated and the latest going on right now in the coast of haiti.

and when i found out the history with all these other pathogens, coming out of wildlife, it actually is amarines bacteria, this is where the major rivers of south asia drain and it's huge wetlands and the water there is half fresh, half salty, it's quite warm, this is perfect for this bacteria to grow in the water and it lives in

conjunction and actually helps recycle nutrients, it's kind of a helpful inhabitant in that environment, people lived in places like the zimmerman, tightly flooded twice a day, there's crocodiles, there's tigers, that all changed in the 19th century when the british decide to chop down and turn them into rice farms, over the course of century, 90% settled. there's people close in intimate contact with colora and allows to spill over into human bodies and adapt to us and what it does in our bodies it's quite different than what it does in the environment. the first pandemic in 1917 and

then russia and europe, and this is exactly what's happening today with our new pathogens. we are invading wildlife habitat or we are disrupting wildlife habitat, we are allowing animals and people to come into contact and when that happens their microbes jump into our body. ebola, camels are giving us and from monkeys we got zika, from birds we've got influenza. this is how we are emerging and we are allowing them to amplify in our cities and crowds and that started and people were

flocking out of the farms to come into the new factory jobs in the city and there wasn't a lot of room to sprawl back then, you know, they didn't have metros to take you to the outlying areas, everyone had to live near work or near the possibility of work. so places like new york city had about 77,000 people per scare kilometer and this meant that they were breathing on each other and touching on each other more, their waste was contaminating and food and water, there's no sewage system in 19th century centralized city, in new york they had outhouses, there's no rules that you had to empty stuff out. people just let it sit and try to decompos but with 77,000 people, that wouldn't happen before the waste actually ran

into the streets, contaminated well water. that process started in 19th century is only reaching its peak now. that just happened a few years ago. the majority of us are going to live in cities by 2030. they're not going to be cities like washington, d.c., san francisco, lots of slums, poor infrastructure, chaotic, but 2 billion people will live in slums, that's the predictions. and so there's no pathogens taking advantage of this right now, the massive urban expansion in poor parts of the world. ebola is a good example of that.

we had ebola in the 1970's, it had never infected places where there's 2,000 inhabitants. only in 2013, within weeks it had infected three capital cities with a combination of 3 million. so that's a really important reason why it was such huge and arguably, i think the zika virus was also taking advantage of urbanization and we had zika virus probably in 1940's and maybe before that but it was mostly in forest and and it was carried by mosquito and that mostly bit animals so people didn't really get a lot of zika virus. right now in the americas zika virus is being carried by mosquito that specializes in

living in human has been tagses, it can actually breed in a drop of water in a bottle cap so all of our plastic garbage that we leave in urban areas are perfect environments for this environment to live in and they only bite humans. the zika virus got into and started to explode too. specially in the tropics have expanded. and then of course, we carry these things around. rivers and here in the united states and of course we connected all of water ways by using steam engines so in 1825 the capable -- canal had opened

into canada and down to new york city and into the entire interior of north america. that happened again and again. we do it much better today. we have not just a few capital cities with airports but hundreds of airports and tens of thousands of connections with all of our airports. this is a map we have in book, you can make a map as connected by direct flights and if you run akimulated on a map like that, it looks like a wave, expanding outwards. you can predict where and when an epidemic will strike simply measuring flights by infected and uninfected cityies.

but the other part of the book is about what we do about it. we have defenses. we have political defenses, we have medical defenses and all kinds of things that we can do to fight back, so it's very interesting to what happened in 1832 and i spent a lot of time trying to die sect. in 1832, carra came down to canada and the government of new york sends doctors up to up state new york to see what was happening s this thing going to threaten the city of new york and he collected this data that has been mapped.

it shows a clear picture, there's cases on hudson river and canal, you can see it coming down, heading straight to new york city, a very clear picture, but nobody in new york want today quarantine the rivers, turn new york into the empire state, this is a huge part of the economy and nobody wanted to close the waterway, which would have been the obvious thing to do, obviously to protect the city at that time. so dr. beck said, well, it might look like callers is coming down the water way but actually it is caused by miasmas, this is 2,000-year-old medical theory that diseases are spread to essentially stinky air, bad smells, that's what they thought

bad smells, immigrant, specially the irish in 1832. this was violent, it wasn't they bad mouthed them in the press, there were massacres in the 19th century. [laughter] >> oh, my god. excuse me, let me look at my notes. wait, yeah, yeah. the doctors, the doctors, yes. this is actually -- it's fun any

that that's where my mind quit because that's actually my favorite part of the story. so they didn't want to quarant quarantine waterways, the slum in the middle of manhattan called five points. if anybody has seen gangs of new york, it was about five points and that's where all of the main -- the worst parts of the epidemic affected and it was because it was crowded and filthy and the slum had built in once upon, it's called a collect pond, the only source of fresh water in manhattan for a long time. the pond had been filled up with garbage and the slum on top of that garbage, so the ground underneath, the 5 point slum was unstable, unlike the rest of

manhattan which is underlined with bedrocks, the ground water was contaminated under this slum, of course, because there were no sewer system, everything -- all their materials sinking down into this ground water. well, the state of new york traded a company to delivery drinking water and that company instead of tapping upstream sources of water, they knew it would taste better for sure, they thought that would cost too much money so they made sort of what happened in flint, michigan, they decided not to tap the good water. they decided instead that they would sink their wells in the middle of that slum and they distributed that water to one-third of the people in new york and this is through repeat ed epidemics. this is the good part, the

person who maneuvered erin byrd. on top of that, the company that did this was called the manhattan company and the reason they wanted to save all this money was because they wanted to start a bank, which they did t bank of the manhattan company and that bank still exists till this day. do you know who it is in jpmorgan chase. biggest bank in america, that is their aerial history. so and i told the story in the book because i think we don't -- we don't really look at the political and social drivers of contagions enough. that's a turnaround in the past. my last book was on malaria and we really got rid of it before we had solid-biomedical

solutions by changing policy basically. we -- we started building dams, of course, but we had engineers and scientist who is were on the boards to make sure we wouldn't extend the mosquito habitat, we changed our housing practices, people started putting screens on the windows and doors, uplifted people sort of poverty in rural areas, give them electricity, ended through the malaria and built it out. this is well before we had ddt and a specific drug to deal with malaria. in the 1940's we started developing chemical cures, penicillin, biomedical establishment and became powerful and potent at curing

disease effectively and we sort of gave public health to our biomedical establishment. and so what happens now when we have outbreaks of diseases, we wait for those epidemics to erupt, people get sick and then we hope that we can throw sufficient vaccineses and drug at it to make it go away. that can make it work in some cases, but what i'm trying to say in this book is it's really not sufficient for new diseases because we don't, when new pathogens come up, we don't have the vaccines all made up, we don't have the drugs and yet these things can spread exponentially.

dengi outbreak, it was centered in key west but sort of in south florida. it hadn't been there in 70 years. that's what we did. florida, the mosquito that is carry dangi had been present in florida for a long time, florida has been surrounded by countries where there is dengi around. you know, that's not new. there hasn't been any invasion that needed to be attacked with the chemical, what happened in 2008 we had the foreclosure crisis and the foreclosure crisis meant we had a lot of abandoned homes and in florida it seems a lot of empty swimming pools and so when the rains came the swimming pools filled up

with water and they became giant mosquito hatcheries and nobody was known to let the mosquito inspectors and we have an unprecedented outbreak in florida. so i don't know if addressing the housing crisis would have helped contain the dengi outbreak in florida because nobody tried that. what i do know arguably that the biomedical model failed. we are continuing to have dengi outbreak in florida. it's considered permanent part of the landscape. what i want to say in this group, as great as our biomedical solutions are, if we can start to prevent pandemics and if we can engage with the root cause of them which are more often political and social, it's not a question of waiting for the perfect cure, it's really a question of our own political will. thank you for listening.

i will take questions too. [applause] >> if you have questions, grab the microphone too. >> i'm really enjoying your book very much. >> excellent. >> i have a question about the zika virus that came right after with your thoughts about political economic and every kind of treatment in terms of the olympics and what -- what given, you know, your theories in the book, what would you suggest? >> well, i think it's a difficult situation because the argument that they're putting in florida of why they should have olympics and why people should come because it's winter there and it's true that when it's dry and cold these mosquitoes either won't hatch as readily because you need standing water for at least a week or even if they do hatch, they won't survive for long enough to transmit the

virus because that takes 7 to 10 days and flows -- slows down if it's cool. that is true, there's going to be less virus around but at the same time, we are living in a time of unstable weather patterns and so all we would need a good rainstorm a week and a half people started to come before the olympics and some of that water to remain standing, those eggs of the mosquito that carry zika, they can last for months. you just need a little bit of water and they'll just come right alive again. so i think it's a risky -- it's a risky endeavor but at the same time there's no stopping zika. it is going to come, in fact, it is probably here in far larger numbers that we know. 80% of people that get it don't have symptoms. so what we are counting is the

tiniest tip of the iceberg, that's counting a lot of the people that have symptoms, it's a rash, fever and they get better. so what we are counting is tiny fraction so it's probably already here in a widespread than we know. if you consider the fact that we have 15 or so suspected cases of sexual transmission already in the united states, if there's 100 introductions supposedly 100 introductions of zika virus in the united states and 15 of those have transmitted sexually, those numbers don't match up. it's probably a pretty rare of transmission, more likely there's many more cases of zika virus. it's going to be a matter of time before we see it manifest itself in a more detectable way. >> so we are in dc, it's hard not to talk about what our government is doing on these issues.

for 12 years i was one of the leaders with dealing with infectious disease, your comment under clinton and bush there were large stats of the national security council focusing on biosecurity because there are 25 agencies and you have to have white house control or you have nothing. obama comes in and he wipes it out. it's not one of the 11th top priorities for the administration in terms of security. it's not even mentioned. and then under bush we had amazing efforts, tens of billions of dollars focused on trying to get development of vaccines, diagnostics and therapeutics, all of that has been dismantled by obama,

actually the explanation was that we heard why they quoteed was cheney thought it was important and we don't. >> right. >> quoted. what is your take of how it's possible given that these are threats where a billion people could die, a billion people could die of flu epidemic if it's roughly the same, you know, as 1918. >> yeah. >> you could have quarantines, you could have panic, how is it possible that this administration has essentially zero interest in this issue? >> i mean, i think you've said it all and i'm not sure you really had a question so much as a comment. [laughter] >> fair enough. absolutely. but i do think that we need to

do even more than that, really, because what i'm trying to talk about in the book is not just let's stop all vaccines and have experts -- and we do need that as well. really to get at the root cause is to look at health care infrastructure in poor parts in the world. do we have enough primary care services to people that are the most vulnerable, what are we doing about intensive agriculture and how are we regulating the way we use land. we are breaking up land all over the place and those are reasons not to do that and this is yet another one, microbes that could spill into the body. we need an approach and expertise that you're talking about, for sure. i would like it to be even more kind of a multifaceted strategy. >> so as you probably know dc

has the highest rate of hiv in the united states, so from like a global per spect i have, what lessons do you think can be learned in approaching epidemics on a smaller scale? >> because dc has center of hiv and so how does that translate -- >> what can you learn from a spread of disease in a smaller population. >> so when you have like -- this is such an interesting aspect of the 1832 epidemics of colora and we had slums in the middle of the city and that was such a driver of epidemics because there's neglected communities right in the middle of new york city and that was knew, in the past poor people were put out of, you know, communities and

with urbanization the slums are started up in the middle of the city and that became center and even ebola is a great example where very simple interventions could have controlled that but we didn't have anything on the ground. even soap and water could have helped controlled the spread of a virus like that but we don't have the services for some of these remote communities and that puts everyone at risk. so that's something i really, you know, i think it's a really big lesson of the history. >> my name is scott and i work for global health organization mainly lobbying the u.s. government oh to focus on strengthening the developing world. so i think it's not ridiculously hard when you take a given country and you know what's killing people in that country,

say in kenya where hiv and milaria are really big killers, it's not ridiculously hard to figure out what investments you can make that will make the greatest difference to saving lives and have the greatest impact. but that gets a lot lot harder when your looking at pandemics, the question of priority setting is so important because we are never going to have all the resources, we really need to set priorities and help us stringening versus building vaccines versus investing laboratories, there's a ton of things we can do but i don't have the ability to say which thing has the biggest bang for our bucks and i would like to hear your thoughts on that. >> you're right. the most glaring lack is health

care, primary health care for poor people in remote places. i was in haiti during the epidemic. this place is so caught off. the thing it's so ironic, so colora had come into this village but they were cut enough that they couldn't get any resources to help them and that just -- it really struck me an uneven development where they had one type of water coming down from the hills that the belgiums had built so when i came there, this pipe of -- they brought the sole drinking water

and it was supposed to be up on a cliff and because there's so much erosion in haiti and slowly falling all the way down to sea level and storms are coming in and hitting the pipe, it had about 32 holes in it and nothing to patch it up, they were using cloths and just wrapping it around. so the water was just dripping out and they had tiny trickle of fresh water coming into the town and that was all of the reason because everyone was getting buckets and leaving it out and when you only have a bucket of water you don't give up eating and cooking, you give up washing as much. to me those are simple things like clean water and aid that's not -- that's sustainable over time and powering local communities. those are all kind of vague things. i'm not a policy person. i'm looking at how these things spread and what are the approaches we can take to help

empower communities to come up with their own solutions, i think that's the hugest lesson of all, when you go into those communities do we ask them, well, what do you think we should do, you know what, i would like 500 beds, no, they don't. they say we would like better water in this town or whatever it is. >> this problem started to develop for us, although i'm from a different part of it, gnomes i'm part of the caribbean haiti has a huge problem i know

there's -- both of europe and the united states of america and other developed countries, they seem to place people tropics and different place, africa, for example, try to figure out new epidemics so that's the first thing maybe you want to talk about. the next thing is complexity of zika that's started to spread in the caribbean, it's not happening in my eye land but only a matter of time. people are saying that, yes, potentially for certain people with certain genetic profiles,

80% don't show a thing, but it was also seemingly a problem that no one is talking about, a lot of these neighborhoods where a lot of this is happening specially with the kids, right, the consequences for the kids that these neighborhoods who are with a lot of pesticides and a lot of stuff, right, and if the zika-more these other elements that has lead to that and have you heard about that and i would like to hear from you, thank you. >> there's theories of why we had in brazil, some of them are easy to say, no, that's definitely not happening. the pesticide theory, to me there's a lot of evidence that's probably not the best. the pesticide that's been used in other parts in the world. still, could it have been used

differently in these certain places, could somehow because of cultural differences or other differences, could those people have gotten a higher dose, i don't know, i think it's a mistake to dismiss alternative theories as conspiracy theories, i think that is what we -- i think that's sort of the conventional response specially from sort of the global health establishment to say stop spreading theories but there's a reason why why the alternate theories come out, they come about because of a lack of trust in our biomedical establishment, and where does that come from? this is something i try to look back, why were some attacked and slaughtered. this happened during epidemics,

burned down quarantined hospitals, we see this again and again, if you walk it back there's and when we dismiss alternate theories, we are dismissing that they don't trust our public health messages and i think it actually makes it worse, well, you're stupid and ignore rant, the same thing with the antivaccines arguments where people say those people are so stupid, of course, it doesn't have cause autism, of course, we do, where does the mistrust come from? people are afraid of industrial

contaminants and corporate secrecy, all of these things, corporate control of medicine, these are worth addressing and why people can't trust these messages and we need that, we need to do that work now because when some big pandemic comes we need to trust our authorities, we need to be on the same page but we are not there yet, we have a lot of pockets of mistrust and conspiracy theories that come up almost immediately. there was the mosquito, the -- you know, all kinds of theories about why this is happening. >> last two questions. >> okay. hi, i'm studying in public health at george washington university and my concentration is environmental policy. right now i'm taking a class health and behavior. my question is how would we work towards creating policy that

would be effective and addressing environmental issues but also perhaps the root cause like social issues as you mentioned earlier? >> i think it's a huge issue like how do people experience disease and what does that mean about what kind of interventions they're going to -- that's going to make sense in their lives. this is a huge issue with malaria which was the topic of my last book where you know, we have hatching a lot of plans to help people in malaria's countries that didn't match up with their own priorityies and bed nets, you don't need refrigeration, you don't need hospitals and robes or anything, these people can be in the more deprived settings and give them intervention and save them from malaria, okay, so we did that, spend hundreds of millions to treated nets and that was a huge effort and a lot of good

intentions and a lot of money and a lot of research and then they weren't used right away. 20% of them were being used or something like that. really low uptake and then they sent anthropologist, well, what's happening, they don't consider malaria a killing disease, they consider a normal problem of their lives, the nets are hot and square, the nicest material they've had in their hut so they are saving when their honored guest come onto take it out. this wasn't considered and it's because people on the ground who have the most malaria, you know, they think of it in a totally different way than we think of it and part of it is immunity, if you survive the gauntlet of the first two years of life and have 12 episode of malaria, you

survive that. if we had african scientists, you people lose $40 billion, it's so simple, we don't need anything fancy, we will give you all of these for free, would we do it? [laughter] we don't even wash our hands during flu season. >> i have sort of a question between the contrast of this book and ted's book, so what are your personal actions that you have done to prepare for pandemics or what do you do on your daily life to avoid epidemic disease? >> i do common sense things, i keep up with vaccinations and i wash my hands and i try to stay informed because each pathogen

is different. i do believe we live in microbial world and disease is part of our relationship to nature and the idea that we should live in some kind of germ-free environment and never have this is really anomolus. you know, we had the first antibiotics in 1940's, by 1980's we started having hiv and lyme disease. so that period of time when we had, you know, this sense, this is a period of time when i grew up and i'm the daughter of two doctors so i grew up with that feeling, infection, like who cares,ly take care of antibiotics, it's simple, i don't need to live with that, that's not going to be part of my life, maybe i was wrong. we are going to adjust to a new